P121. The clinical characteristics of Crohn's disease patients with free perforation in Korea
Y.S. Kim1, Y.S. Doh1, H.J. Jung1, J.h. Cheon2, Y.-H. Kim3, B.D. Ye4, J.W. Kim5, J.P. Im5, J.S. Kim5, 1Inje University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 2Yonsei University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 3Sungkyunkwan University School of Medicine, Internal Medicine, Seoul, Korea, Republic of, 4University of Ulsan College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 5Seoul National University College of Medicine, Internal Medicine, Seoul, Korea, Republic of
The incidence of Crohn's disease (CD) is increasing in Korea. Major complications of CD are fistulas, bowel strictures, and free perforation. Among these, free perforation is the most severe and debilitating complication, usually requiring emergency surgery. A higher incidence of perforation has been reported in Japan than in western countries. However, no large-scale studies concerning perforations in Korean CD patients have been conducted. The aim of this study was to investigate the clinical characteristics and risk factors for Korean patients with CD who present with perforation.
The Crohn's Disease Network Project was conducted in Korea; CD patients who were diagnosed between 1984 and 2008 were included in our retrospective CD cohort. We investigated anatomical areas of perforation, clinical features of patients with perforation, and operation history. We calculated, using logistic regression analysis, the association between these clinical features and free perforation in patients with CD. We also evaluated the mortality rate due to perforation using relative risk (RR).
In our study, 1,338 patients were enrolled from the 28-center retrospective CD cohort and 116 patients (8.7%) with perforation were identified. The mean age of the patients with perforation diagnosed with CD was 32.2±10.9 years, which is significantly higher than the patients without perforation (28.4±12.3 years) (p < 0.05). Free perforation was the presenting sign of CD in 63 patients (54%) and developed after diagnosis of CD in 53 patients (46%). Of the 116 patients of perforation, 101 involved the ileum, 5 the jejunum, and 10 the colon, and 5 patients had perforations at multiple sites. Surgery was performed on 111 patients (95.7%), though 5 patients had no available surgical records. By multivariate analysis, free perforation had a significant association with older age at diagnosis (p = 0.013) and bowel stricture (p = 0.028), but did not show any significant association with medications, including steroids, azathioprine, and infliximab. The mortality of patients with free perforation was higher (4.3%; RR = 6.63, 95% CI 2.20–19.92, p < 0.001) than that of patients without perforation (0.65%).
The incidence of free perforation in Korean patients with CD was 8.7% higher than that in western countries. Old age at diagnosis and bowel stricture were confirmed as significant risk factors for free perforation, which indicated a poor prognosis of CD. Early diagnosis of CD is therefore important in reducing free perforation in patients with CD.